breast.png
859.255.6649

Patient Forms

*Actual Patient

Patient Forms

We have provided patient forms below as a convenience for you to make your experience with Wells Plastic Surgery and Skin Care more efficient.  Please print and complete each of these patient forms prior to your office visit.  This will greatly cut down on the time you will spend prior to your appointment, and give you time to answer all questions thoroughly.  It can also keep from time filling out forms from taking away from your appointment time.  Make sure you provide updated email information so you will receive information on services and events.

Health History

This form will give us a complete background of your health and prior surgery and procedure history so we can better serve you.  Please answer as completely as possible so we will be able to develop the very best plan of care for you.

Patient Information

This form will provide all your current personal information and emergency contacts.  If you have filled this out in the past and your information has changed let us know.  You may be asked to complete a new for for your file.

Skin Care Assessment

This form is for clients of our Skin Care Program only. It does not need to be completed for our cosmetic surgery patients.  It will let you give us a thorough idea of your skin type and sensitivities. If you give us a complete history of your skin issues we can better develop a plan for you.

HIPAA

This form outlines our privacy policy. Our HIPAA compliance aligns with state guidelines for your privacy and safety.

Testimonials

"Before Voluma everyone was always asking me if I was sick or sad – and that’s enough to make you sad. After Voluma I get “Hello” and “How are you”, no more sick and sad, just a lot of smiles. I never smiled before Voluma, now I can’t stop smiling."

—Cynthia

"Susan does all my skin care and this is the best my face has ever looked. I wish I had come to her years ago. She is honest, not pushy, gives you options and is very concerned. She wants to make you feel good."

—Mary

"My experience with Dr. Wells and his team was amazing. I was always treated like family, yet professional at the same time. I appreciate Dr. Wells and his surgical team boosting my self-confidence, especially the moment I walked through the surgery center door. Thank you Dr. Wells for helping me love my body again."

—Brittany

"Dr. Wells and his staff surpassed any expectations I had. They were with me with each step of the process. The kindness and compassion shown went above and beyond. They are truly the best and the results are fantastic. I am so thankful for my experience."

—Leslie

"Wonderful Doctor & staff…great experience and amazing results. Thank you for everything."

—Amanda

"I love the results of my surgery. I would tell any mother that is thinking of having Mommy Makeover surgery to do this for herself. I also LOVE Dr. Wells and his staff – they were all great."

—Lisa

"I had great big bags under my eyes that had become permanent after a sad period in my life.  Rejuvapen literally swept the bags away and made my under eyes smooth again.  I couldn't believe it!"

—Christi

"For my chronic acne Susan began treatments on my face including chemical peels that put my skin in the freshest, best shape possible to allow my skin to heal.  After a month and a half my skin was completely clear."

—Rachel

"Building on Dr. Wells' reconstruction work, Susan Wells accentuated my chin by using Juvederm to give it additional contours and a very natural look. I am beyond thrilled and honestly amazed at how good I look now."

—Stacey

"I was always embarrassed to go to the pool or the beach because of all the hair on my back. I was constantly shaving where I could before I went out. Having Laser Hair Reduction on my back has been life changing. I literally feel like a new man."

—Reed

"I had my brows done back in December, Bailey Rae Hancock is awesome. I have had tons of compliments, wish I had done it sooner!"

—Susan

"I'll start by saying I'm a 39 year old male and slowly over time I have lost a lot of volume in my face. I'm very happy with the results and Rachel is top notch. Very kind and personable and has treated me with honesty and care. Also very recently I have had flare ups of cystic acne and have been seeing Lisa Combs for that. The first time I saw her I had a chemical peel and a couple weeks ago I had an IPL Acne treatment. My face has not been this clear in a long time. "

—Nathan B.

"Dr. Wells was wonderful doing my breast reduction/lift surgery. I am so pleased with my results and wish I would have done it sooner! His staff are all so sweet and welcoming. He has great bedside manner as well.  "

—Another happy Wells patient

Our Monthly Specials

  • We now offers Biopelle skin care products.  Biopelle Tensage Intensive Serum 50 has unique and natural Growth Factors that visibly reduces deep wrinkles, irregular pigmentation, sallow skin and dryness/roughness. We also carry Biopelle for eye, Tensage 40 and more.

     

    More Specials
  • $550 Free Botox with Breast Augmentation

    Get a Botox Bonus with Breast Augmentation.

    More Specials
  • Our Latisse 3 ml price is just $110! The lowest in the area.

    More Specials
  • Due to overwhelming response the Wells ReFresh Club membership is now temporarily closed.  If you would like to join we are taking names on a waiting list.  You will be the first to be contacted when an opening comes up.  Being ReFRESHED is quite the thing at Wells Skin Care!

    More Specials